Transesophageal Echocardiographic Assessment of Venous Carbondioxide Embolism during Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: Although major CO2 gas embolism has occurred rarely during laparoscopic cholecystectomy (LC), the incidence of less severe episodes of CO2 embolism is unknown. It is also possible that such gas embolism, if present, could affect to cardiorespiratory variables. This study was designed to assess the incidence of subclinical embolic events using transesophageal echocardiography (TEE) and to evaluate the related hemodynamic consequence during LC. METHODS: With IRB approval, 20 patients undergoing LC were studied. The long axis four chamber view was obtained continuously, except for predetermined intervals where the transgastric short axis view was obtained to derive ejection fraction (EF). Heart rate, mean arterial pressure, O2 saturation, and end-tidal CO2 were monitored. Statistical analysis was performed using multivariated ANOVA and unpaired Student's t-test. P<0.05 was considered significant. RESULTS: We observed gas embolism in 4/20 patients during CO2 insufflation and 20/20 patients during gallbladder (GB) dissection. There was no significant difference in cardiorespiratory variables between embolic and nonembolic patients during insufflation. Also there was no significant difference in cardiorespiratory variation in all patients with embolism between before and after GB dissection. EF decreased significantly after insufflation (P = 0.002) and was recovered after exsufflation (P = 0.001). This can be explained by increase in systemic vascular resistance (SVR). CONCLUSIONS: Embolic events commonly occur during CO2 insufflation and GB dissection without cardiorespiratory instability. Although embolic event itself didn't affect the hemodynamic variables, peritoneal insufflation increased SVR and decreased EF. We should pay attention to patients undergoing LC who have decreased cardiac function and also prepare for serious CO2 embolic event.

Differential Analgesic and Adverse Effects of 0.125% Bupivacaine vs. Ropivacaine Coadministered Epidurally with Morphine / 대한마취과학회지

BACKGROUND: This study aimed to compare analgesic efficacy and occurance of motor block and other side effects of a 48 hr postoperative continuous epidural infusion of 0.125% bupivacaine or ropivacaine with morphine. METHODS: Forty patients undergoing a Cesarean section were allocated randomly into two groups. Both groups received an epidural injection of 2.0% lidocaine 18 20 ml and 0.5% bupivacaine 2 5 ml with fentanyl 50microgram 20 minutes before surgical incision and received 2 mg of epidural morphine by bolus 40 minutes after surgical incision. For post-operative pain control, a continuous epidural infusion was started using a two day infusor containing 6 mg of morphine in 100 ml of 0.125% bupivacaine (Group 1, n = 20) or 100 ml of 0.125% ropivacaine (Group 2, n = 20). Visual analog scale (VAS) for pain during rest and movement, sensory change and motor blockade were assessed for 48 hrs. after surgery. RESULTS: There were no significant differences in VAS for pain during rest and movement. The incidences of side effect were similar in both groups. CONCLUSIONS: Using 0.125% bupivacaine with morphine via the epidural route provided similar pain relief and side effects as 0.125% ropivacaine with morphine.

New Operation Method on the Cicatricial Entropion and the Distichiasis

The term "entropion" is defined as a turning inward of the eyelid. Depending on the mechanism of its causation, it may be classified into four types; mechanical, spastic, senile, and cicatricial. Cicatricial entropion follows scarring of the palpebral conjunctiva, which may be caused by trauma, chemical injuries, infections such as trachoma, benign ocular pemphigus, Stevens-Johnson syndrome, and eyelid surgery. Distichiasis is a rare congenital anomaly in which aberrant separate row of lashes usually composed of hairs smaller than normal, appears along the posterior lid margin. Numerous surgical procedures have been described for surgical correction of cicatricial entropion and distichiasis in accordance with the severity of the condition. We have treated cicatricial entropion in 6 eyes(8 lids) and distichiasis in 3 eyes (3 lids) with sliding tarsoconjunctival grafting, and the results were satisfactory.